PCC Community Wellness Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

PCC COMMUNITY WELLNESS CENTER

Doing business as

PCC Clinic at Thrive

Practice address

120 S Marion St
Oak Park, IL 60302-2809

Phone

(708) 383-7500

NPI assigned

Sep 13, 2010

Last updated

Sep 13, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

PCC COMMUNITY WELLNESS CENTERAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert J Urso

Title

President and Ceo

Phone

(708) 383-9786

Specialties & licenses 1

Addresses

Other names 1

• PCC Clinic at Thrive Doing business as

Part of

PCC Community Wellness Ctr

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284336000000",
    "number": "1427365311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ERIE CT",
            "address_2": "SUITE 4125",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022566",
            "telephone_number": "708-406-3912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S MARION ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022809",
            "telephone_number": "708-383-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCC COMMUNITY WELLNESS CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PCC COMMUNITY WELLNESS CENTER",
        "enumeration_date": "2010-09-13",
        "last_updated": "2010-09-13",
        "status": "A",
        "authorized_official_last_name": "URSO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "708-383-9786",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCC Clinic at Thrive",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Federally Qualified Health Center (FQHC) in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.